Deep Gluteal Space

spatium gluteale profundum

The deep gluteal space is the anatomical region between the gluteal muscles and the posterior hip joint capsule, extending from the pelvis to the proximal femur. It contains the sciatic nerve, the inferior gluteal nerve and artery, the pudendal nerve, and the external rotator muscles (piriformis, obturator internus, gemelli, quadratus femoris). The space is bounded by the sacrotuberous ligament posteriorly and the proximal femur anterolaterally.

Anatomical Data

Boundaries & Contents

Location	Buttock, beneath gluteus maximus and behind the hip joint
Boundaries	Gluteus maximus (behind) Posterior acetabulum, hip capsule and proximal femur (front) Sacrotuberous ligament and falciform fascia (medial) Lateral lip of the linea aspera and iliotibial tract (lateral) Lower edge of the greater sciatic notch (above) Hamstring origin at the ischial tuberosity (below)
Contents	Sciatic nerve Piriformis, gemelli, obturator internus and quadratus femoris Superior and inferior gluteal nerves and vessels Pudendal nerve (briefly, medially) Posterior femoral cutaneous nerve Nerves to obturator internus and quadratus femoris

Biomechanics

Function & Actions

Holds the sciatic nerve and short hip rotators in a fat-filled plane that lets them move with the hip. Entrapment of the sciatic nerve anywhere in this space causes deep gluteal syndrome.

Clinical Relevance

Clinical Notes

Deep gluteal syndrome (previously called non-discogenic sciatic nerve entrapment or piriformis syndrome) encompasses all causes of sciatic nerve compression within the deep gluteal space from any aetiology, piriformis hypertrophy, fibrovascular bands, hamstring origin scarring, obturator internus variants, and anatomical nerve-piriformis relationships. Endoscopic deep gluteal space surgery (hip arthroscopy extended to the deep gluteal space) allows visualisation and decompression of the sciatic nerve throughout this space.

Pathology

Common Injuries & Conditions

Endoscopic Deep Gluteal Space Decompression for Non-Discogenic Sciatica

Sciatic nerve entrapment within the deep gluteal space from fibrovascular bands, piriformis anomalies, or hamstring origin fibrosis produces sciatica unrelated to disc pathology; endoscopic deep gluteal surgery through hip arthroscopy portals identifies and releases compressive structures along the nerve from the greater sciatic notch to the posterior thigh.

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